title: Integrating health and environmental impact analysis.
abstract: Scientific investigations have progressively refined our understanding of the influence of the environment on human health, and the many adverse impacts that human activities exert on the environment, from the local to the planetary level. Nonetheless, throughout the modern public health era, health has been pursued as though our lives and lifestyles are disconnected from ecosystems and their component organisms. The inadequacy of the societal and public health response to obesity, health inequities, and especially global environmental and climate change now calls for an ecological approach which addresses human activity in all its social, economic and cultural complexity. The new approach must be integral to, and interactive, with the natural environment. We see the continuing failure to truly integrate human health and environmental impact analysis as deeply damaging, and we propose a new conceptual model, the ecosystems-enriched Drivers, Pressures, State, Exposure, Effects, Actions or 'eDPSEEA' model, to address this shortcoming. The model recognizes convergence between the concept of ecosystems services which provides a human health and well-being slant to the value of ecosystems while equally emphasizing the health of the environment, and the growing calls for 'ecological public health' as a response to global environmental concerns now suffusing the discourse in public health. More revolution than evolution, ecological public health will demand new perspectives regarding the interconnections among society, the economy, the environment and our health and well-being. Success must be built on collaborations between the disparate scientific communities of the environmental sciences and public health as well as interactions with social scientists, economists and the legal profession. It will require outreach to political and other stakeholders including a currently largely disengaged general public. The need for an effective and robust science-policy interface has never been more pressing. Conceptual models can facilitate this by providing theoretical frameworks and supporting stakeholder engagement process simplifications for inherently complex situations involving environment and human health and well-being. They can be tools to think with, to engage, to communicate and to help navigate in a sea of complexity. We believe models such as eDPSEEA can help frame many of the issues which have become the challenges of the new public health era and can provide the essential platforms necessary for progress.
authors.affiliation: NERC Centre for Ecology & Hydrology, Bush Estate, Penicuik EH26 0QB, UK. Electronic address: srei@ceh.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Reis
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro Cornwall TR1 3HD, UK.
authors.forename: G
authors.initials: G
authors.lastname: Morris
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro Cornwall TR1 3HD, UK.
authors.forename: L E
authors.initials: LE
authors.lastname: Fleming
authors.affiliation: NHS Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow G2 6QE, UK.
authors.forename: S
authors.initials: S
authors.lastname: Beck
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro Cornwall TR1 3HD, UK.
authors.forename: T
authors.initials: T
authors.lastname: Taylor
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro Cornwall TR1 3HD, UK.
authors.forename: M
authors.initials: M
authors.lastname: White
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro Cornwall TR1 3HD, UK.
authors.forename: M H
authors.initials: MH
authors.lastname: Depledge
authors.affiliation: NERC Centre for Ecology & Hydrology, Bush Estate, Penicuik EH26 0QB, UK; Geography, College of Life & Environmental Sciences, University of Exeter, Amory Building, Rennes Drive, Exeter EX4 4RJ, UK.
authors.forename: S
authors.initials: S
authors.lastname: Steinle
authors.affiliation: Geography, College of Life & Environmental Sciences, University of Exeter, Amory Building, Rennes Drive, Exeter EX4 4RJ, UK; European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro Cornwall TR1 3HD, UK.
authors.forename: C E
authors.initials: CE
authors.lastname: Sabel
authors.affiliation: Institute of Occupational Medicine, Research Avenue North, Riccarton, Edinburgh EH14 4AP, UK.
authors.forename: H
authors.initials: H
authors.lastname: Cowie
authors.affiliation: Institute of Occupational Medicine, Research Avenue North, Riccarton, Edinburgh EH14 4AP, UK.
authors.forename: F
authors.initials: F
authors.lastname: Hurley
authors.affiliation: NERC Centre for Ecology & Hydrology, Bush Estate, Penicuik EH26 0QB, UK.
authors.forename: J McP
authors.initials: JM
authors.lastname: Dick
authors.affiliation: NERC Centre for Ecology & Hydrology, Bush Estate, Penicuik EH26 0QB, UK.
authors.forename: R I
authors.initials: RI
authors.lastname: Smith
authors.affiliation: Plymouth Marine Laboratory, Prospect Place, The Hoe, Plymouth PL1 3DH, UK.
authors.forename: M
authors.initials: M
authors.lastname: Austen
mesh_terms: D057231:Climate Change; D017753:Ecosystem; D006801:Humans; D011634:Public Health
keywords: Conceptual framework; Ecosystem services; Environment; Health; Impact assessment